E. Symptomatology

1. The Patient

As it is the physician's business to cure the sick (at least, that
is what nearly all laymen, and perhaps ninetynine and nine-tenths per
cent of the profession, believe), those who are uncomfortable or in
pain place themselves under the care of a physician to be made well,
and when the pain is gone a cure is supposed to have been wrought.

The patient presents symptoms, some of which are subjective and a
part of which are objective. The subjective symptoms are those about
which the patient knows, while the objective symptoms are the changes
of the exterior and interior about which the physician knows.

The subjective symptoms are those that have developed in the
consciousness of the patient. They may have come on rapidly, or they
may have come on very slowly.

The history of disease is that of a coming-on and a going off of
discomfort; and on the revolutions--the cycles--made by diseases rests
the reputation of all systems of palliation. The patients feel bad,
and the doctors of high and low degree, representing schools whose
scientific data--theories of cause and cure--are poles apart, and
whose therapeutics range from conceit to the fanciful and on to the
grotesque, gather around their victims and administer their
"dope;" when, behold! as if by the touch of the lamp of
Aladdin, the victims are blessed by the remedies, in spite of the fact
that these are as opposite in their specific actions as it is possible
for them to be. Yet the sufferers are "cured"! Of course,
it matters not if the patients are sick again in a week, or a month,
or a year, with the selfsame disease--another fanciful
"cure" is made, which again our doctors and patients
celebrate in the usual way, by telling in scientific terms just how it
came about, even the wisest among them being ignorant of the fact that
the natural progress of all disease is rhythmical or cyclical--better
and worse--until the organism is broken down, and then the patient is
better and worse, but never well, until death gives full relief.

It is the history which the patient recites to the physician; and
it is the physician's business to weigh, analyze, and criticize what
the patient tells him, and, by a physical examination, to determine
just what the derangement of body is.

It should be borne in mind that the diagnosis of the exact
derangement--discovering just what organ is affected, and determining
whether the disease is functional or organic innocent (benign) or
malignant--is very far from discovering the primary and insidious
cause, without which discovery the treatment must be palliative. There
is no cure short of removing the primary or initiative cause. If the
initiative cause has passed away, then the secondary cause, which is
doing primary work, must be discovered and removed.

The patient may be making his first call upon the doctor. He may be
having his first pain or discomfort, or he may have had many attacks
of sickness and pain.

The discomfort that caused the patient to seek relief may be a link
in a chain of morbid derangements leading back to childhood, or even
infancy--not on the order of heredity, for nothing is inherited except
a predisposition to be sick in a given way; but if the tendency ever
becomes a realization, habits that pervert nutrition must be practiced
long enough to break down resistance and start the morbid tendencies
to work.

It is necessary to get all the history of the life of the patient,
and, when possible, the family history, age, sex, habits, occupation,
temperament, beliefs, environments, mode and manner of the care of the
body.

It is necessary to know all about the life which the patient is
living, and all about the life which he has lived, if he has changed
his style recently. It is not only necessary to know the physical
habits of the patient, but his mental habits as well; and, in
addition, the physician must have the confidence of the patient and
know his secret life. The physician must enter into the relationship
of "father confessor" with every important case that calls
upon him. If he has not the personality to secure this confidence, and
draw out the secrets that are hidden in the occult chamber of the
individual's soul, he is not possessed of those qualities of character
which make for healing. The doctor must have sympathy--not, however,
without firmness and sternness, when necessary. The quality of
selfishness in a doctor must be covered by a very large coating of
politic politeness, or he will not draw patients, and certainly will
not be a physician at any time. If his selfishness is pronounced, it
is liable to be subconsciously interpreted by the patient, and this
knowledge kills influence.

Lost self-confidence, self-respect, and self-control are the
psychical elements with which the patient contends in chronic
diseases, and which make management of a cure impossible for the
selfish, vain, and unsympathetic doctor; for only the sympathetic can
draw confessions--and confession is necessary to cure.

It is well, this early, to disabuse the mind of any reader of the
idea which he may have that a successful curing system is, or can be,
based on a set of cut-and-dried formulas. Indeed not; every case is
different and a law unto itself. The only thing that is fixed and
unchangeable is the natural laws within and without the patient. It is
our attitude before the law that determines health or disease. If our
actions agree with the law of our being, or the environment, all is
well.

Health results from an agreeable adjustment of the body and mind to
natural law and order; and impaired health--a lowered health standard,
called disease--comes from disagreeable adjustment of the body and
mind to natural law and order.

Diagnosis is determining the symptoms and learning just what is the
cause of the morbid process, and its effect on the body.

I practiced medicine in the orthodox manner for twenty-five
years. A number of those years were spent in determining just how much
my treatment had to do with the recovery of my patients, and how much
it did not. Little by little my drug superstition sloughed off. Not
rapidly, but little by little, I learned that the physician is a
woefully deluded man.